Provider Demographics
NPI:1629103692
Name:DEGIROLOMO, JENNIFER A (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:DEGIROLOMO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:WEDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:30 STEVENS ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3859
Mailing Address - Country:US
Mailing Address - Phone:203-852-2742
Mailing Address - Fax:203-855-3699
Practice Address - Street 1:30 STEVENS ST
Practice Address - Street 2:SUITE H
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3859
Practice Address - Country:US
Practice Address - Phone:203-852-2742
Practice Address - Fax:203-855-3699
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002295225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics